Poor Man's Heroin

Biology 103
2002 First Paper
On Serendip

Poor Man's Heroin

Brie Farley

A plaintiffs group in Washington D.C. has filed a $5.2 billion lawsuit against Purdue Pharma LP and Abbott Laboratories Inc. charging the drug companies with allegedly failing to warn patients the painkiller OxyContin is dangerously addictive. Do you think they'll win?

" Oxy, oxies, oxycotton, OC s, killers, oceans, O's, oxycoffins, Hillbilly Heroin." Each of these words is another name for the drug, OxyContin, marketed by Purdue Pharma LP. Addiction and abuse of the drug, crime and fatal overdoses have all been reported as a result of OxyContin use. (1).

This drug was approved by the FDA in 1995, and is a 12-hour time-released form of oxycodone, an opium derivative, which is the same active ingredient in Percodan and Percocet. OxyContin is the longest lasting oxycodone on the market. Opiates provide pain relief by acting on opioid receptors in the spinal cord, brain, and possibly in the tissues directly. Opioids, natural or synthetic classes of drugs that act like morphine, are the most effective pain relievers available. (2).

Oxycodone has been around for decades and taken for post surgical pain, broken bones, arthritis, migraines and back pain. Oxycodone is a central nervous system depressant. Its appears to work through stimulating the opioid receptors found in the central nervous system that activate responses ranging from analgesia to respiratory depression to euphoria. While Percocet and Percodan have about five milligrams of oxycodone, OxyContin tablets contain oxycodone in amounts of 10, 20, 40, and 80 milligrams. ( 4). A 160- milligram tablet became available in July 2000. Thus, OxyContin is a high potency painkiller, intended only for use by terminal cancer patients and chronic pain sufferers. People who take the drug repeatedly can develop a tolerance or resistance to the drug's effects. A cancer patient can take a dose of oxycodone on a regular basis that would be fatal in a person never exposed to oxycodone. Most individuals who abuse oxycodone seek to gain the euphoric effects, mitigate pain, and avoid withdrawal symptoms associated with oxycodone or heroin abstinence. The strength, duration, and known dosage of OxyContin are the primary reasons the drug is attractive to abusers and legitimate prescribers.

Although designed to be swallowed whole, abusers have found other ways to ingest OxyContin. Abusers often chew tablets, or crush the tablets and snort the powder. Because oxycodone is water soluble, crushed tablets can be dissolved in water and the solution can be injected. Both of these methods lead to rapid release and the absorption of oxycodone. Combining any use of OxyContin with alcohol is deadly. OxyContin and heroin have similar effects, so both appeal to the same abuser population. The powerful prescription pain reliever has become a hot new street drug. It s the so-called poor man s heroin, says Capt. Michael Holsapple of the Kokomo Police Department. (5). A 40 mg tablet of OxyContin by prescription costs approximately $4 or $400 for a 100-tablet bottle in a retail pharmacy. Generally, OxyContin sells for between 50 cents and $1 per mg on the street. Therefore, the same 100-tablet bottle purchased for $400 at a pharmacy can sell for $2,000 to $4,000 illegally. How does this compare to the street price of heroin? One bag of heroin sells for about $40, according to 1998 findings in Ireland. (6,7). A bottle of OxyContin containing one hundred tablets is clearly more for the money. (4).

Sometimes, OxyContin can be obtained easily in clinics. For a brief visit and the appropriate presenting complaint, patients may leave with a prescription for OxyContin. Many physicians are not formally trained to identify drug-seeking behavior. (4). In April 2002, the US Drug Enforcement Agency reported that OxyContin has been implicated as the direct cause of main contributing factor in 146 deaths and a likely contributor in an additional 318 deaths. Based on their findings, only nine of the reported deaths involved injecting the drug and only one death related to snorting. This indicates even non-abusers may be adversely affected. It has been alleged that Purdue Pharma L.P has marketed the drug excessively while underplaying how addictive it is. Reported warnings about the drug found on the Internet include:

1. This medicine can be habit-forming. You should not use more than the prescribed amount.

2. Whole oxycodone tablets may appear in your stool. This is no cause for worry because the medicine is absorbed when the tablet is still in your body.

3. If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.

4. This medicine can cause dizziness or drowsiness. Be careful if driving a car or using machinery.

5. If you have taken this medicine for several weeks, ask your doctor before stopping, as you may need to take smaller and smaller doses before you stop the medicine completely. (5).

These precautions are not uncommon for any prescription pain reliever. However, Purdue Pharma LP has not included information regarding the drug s similarity to heroin, and has not stressed the severity of the complications. A recent newspaper article reported that OxyContin s sales, which exceeded $1 billion in the United States in the year 2000, are said to be the result of an aggressive marketing strategy to physicians, pharmacists and patients that misrepresented the appropriate uses of OxyContin and failed to adequately disclose and discuss the safety issues and possible adverse effects of OxyContin use (4) .

Seven people who are former addicts or relatives of addicts filed the Washington D.C. lawsuit. In May, Purdue said it had met with officials from the DEA because of the agency s concerns about its illegal diversion and abuse. Around the same time, Purdue Pharma said it tried to reduce abuse of the drug by halting distribution of the drug in 160mg tablets. According to the lawsuit, defendants, made misrepresentations or failed to adequately and sufficiently warn individuals regarding the appropriate uses, risks, and safety of OxyContin. Specifically, the suit quotes a May 2000 U.S. Food and Drug Administration warning letter to Purdue Pharma ordering the company to cease use of an advertisement for the drug that appeared in a medical journal. A section from the warning letter is quoted that suggests the advertisement inaccurately represents the drug as a first-line treatment for osteoarthritis. The suit alleges inappropriate marketing of OxyContin, that the drug has been inappropriately prescribed and used, unnecessarily putting people at risk of addiction to OxyContin (4).

Should it be assumed that the general public is aware of the effects of opiates? Is it the responsibility of the physician to be suspect of warning labels on every newly marketed drug? Does the word "addiction"? always prevent chronic pain sufferers from taking a miracle drug ? And finally, will anyone, especially teens, ever stop experimenting with drugs? Your answers to the above questions were probably doubtful, but this does not mean that the D.C. lawsuit isn t worth fighting for. We should be personally careful, but we also need to emphasize our right to be thoroughly and accurately informed about what we put in our bodies.

WWW Sources

2) Government Information about OxyContin , Facts

3) About OxyContin , Facts and Information

4) OxyContin Addiction Help , Facts and Resources where to get help from addiction

5) Yahoo Health , Basic Information

6) MapInc , Article about the increase in Heroin prices in Ireland

7) Oanda , Monetary Conversion Site

Comments made prior to 2007

It's my studied opinion that oxycodone , in any form , has no reason (NONE) for inclusion in the U.S.P. . The analgesic properties of this drug are , in fact , minimal . It's therapeutic window of efficacy is dangerously narrow . It is unfortunate that other Schedule II medications , such as M.S. , have been historically branded as "evil" , thereby elevating the very much more dangerous , ineffective , and costly drug to a status of legitimacy .

If one were truly open-minded and interested in ameliorating moderate to severe pain , effort should be expended towards the decriminalization of cannabis . ... but then that would probably obviate the need for 30% to 40% of the worlds pharmaceutical companies ! ... W.M. Martin, 7 December 2006

i had acl reconstruction in 03 and 05 and the doctor just kept giving me lortab 10, percocet 10, zanax 2mg and soma over and over for 4 yrs they didnt try other routes and now im addicted and have to go to a methadone center to het off. do i have a case? ... Scott Powers, 24 October 2007